Lung cancer is the most common cause of death from cancer in males,accounting for more than 1.4 million deaths in 2008.It is a growing concern in China,Asia and Africa as well.Accurate staging of the disease is an im... Lung cancer is the most common cause of death from cancer in males,accounting for more than 1.4 million deaths in 2008.It is a growing concern in China,Asia and Africa as well.Accurate staging of the disease is an important part of the management as it provides estimation of patient’s prognosis and identifies treatment sterategies.It also helps to build a database for future staging projects.A major revision of lung cancer staging has been announced with effect from January 2010.The new classification is based on a larger surgical and non-surgical cohort of patients,and thus more accurate in terms of outcome prediction compared to the previous classification.There are several original papers regarding this new classification which give comprehensive description of the methodology,the changes in the staging and the statistical analysis.This overview is a simplified description of the changes in the new classification and their potential impact on patients’ treatment and prognosis.展开更多
Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA) is useful for the primary diagnosis of pulmonary embolism(PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE beca...Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA) is useful for the primary diagnosis of pulmonary embolism(PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography(CTA). In this review, we discuss the strengths and weaknesses of CEMRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multiinstitutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women(< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness(patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.展开更多
In recent years,the use of light to selectively and precisely activate drugs has been developed along the fundamental concepts of photopharmacology.One of the key methods in this field relies on transiently silencing ...In recent years,the use of light to selectively and precisely activate drugs has been developed along the fundamental concepts of photopharmacology.One of the key methods in this field relies on transiently silencing the drug activity with photocleavable protecting groups(PPGs).To effectively utilize light-activated drugs in future medical applications,physicians will require a reliable method to assess whether light penetrates deep enough into the tissues to activate the photoresponsive theragnostic agents.Here,we describe the development and evaluation of magnetic resonance(MR)imaging agents that allow for the detection of light penetration and drug activation in the tissues using non-invasive whole-body magnetic resonance imaging(MRI)and chemical exchange saturation transfer(CEST)-MRI modalities.The approach relies on the use of PPG-protected MR contrast agents,which upon irradiation with light change their imaging signal.A Gadolinium(III)-based MRI contrast agent is presented that undergoes a significant change in relaxivity(25%)upon uncaging,providing a reliable indicator of lightinduced cargo release.Additionally,we introduce the first light-responsive CESTMRI imaging agent,enabling positive signal enhancement(off-to-on)upon light activation,offering a novel approach to visualize the activation of photoactive agents in living tissues.This research provides a proof-of-principle for the noninvasive,whole-body imaging of light penetration and drug activation with high temporal resolution characteristic of MR methods.展开更多
This article explains the phasing in the design of associate degree programs in the Netherlands.The associate degree is a degree on Level5 and is described in this article.The associate degree programs organize themse...This article explains the phasing in the design of associate degree programs in the Netherlands.The associate degree is a degree on Level5 and is described in this article.The associate degree programs organize themselves in new developed Regional Associate Colleges.Design teams consists of teachers from different institutes.The design team leader’s tasks and focus within the different phases in designs is addressed.展开更多
Urban population growth is driving the expansion of urban and peri-urban agriculture(UPA)in developing countries.UPA is providing nutritious food to residents but the manures produced by UPA livestock farms and other ...Urban population growth is driving the expansion of urban and peri-urban agriculture(UPA)in developing countries.UPA is providing nutritious food to residents but the manures produced by UPA livestock farms and other wastes are not properly recycled.This paper explores the effects of four scenarios:(1)a reference scenario(business as usual),(2)increased urbanization,(3)UPA intensification,and(4)improved technology,on food-protein self-sufficiency,manure nitrogen(N)recycling and balances for four different zones in a small city(Jimma)in Ethiopia during the period 2015-2050.An N mass flow model with data from farm surveys,field experiments and literature was used.A field experiment was conducted and N use efficiency and N fertilizer replacement values differed among the five types of composts derived from urban livestock manures and kitchen wastes.The N use efficiency and N fertilizer replacement values were used in the N mass flow model.Livestock manures were the main organic wastes in urban areas,although only 20 to 40%of animal-sourced food consumed was produced in UPA,and only 14 to 19%of protein intake by residents was animal-based.Scenarios indicate that manure production in UPA will increase 3 to 10 times between 2015 and 2050,depending on urbanization and UPA intensification.Only 13 to 38%of manure N will be recycled in croplands.Farm-gate N balances of UPA livestock farms will increase to>1 t·ha−1 in 2050.Doubling livestock productivity and feed protein conversion to animal-sourced food will roughly halve manure N production.Costs of waste recycling were high and indicate the need for government incentives.Results of these senarios are wake-up calls for all stakeholders and indicate alternative pathways.展开更多
Aim: To examine the correlation between neonatal cranial ultrasound and school age magnetic resonance imaging (MRI) and neurodevelopmental outcome. Methods: In a prospective 2 year cohort study, 221 children (gestatio...Aim: To examine the correlation between neonatal cranial ultrasound and school age magnetic resonance imaging (MRI) and neurodevelopmental outcome. Methods: In a prospective 2 year cohort study, 221 children (gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g) participated at a median age of 8.1 years (inclusion percentage 78% ). Conventional MRI, IQ (subtests of the WISC), and motor performance (Movement Assessment Battery for Children) at school age were primary outcome measurements. Results: Overall, there was poor correspondence between ultrasound group classifications and MRI group classifications, except for the severe group (over 70% agreement). There was only a 1% chance of the children with a normal cranial ultrasound having a major lesion on MRI. Mean IQ (standard deviation) was significantly lower in children with major ultrasound or MRI lesions, but was also lower in children with minor lesions on MRI compared to children with a normal MRI (91 ± 16, 100 ± 13, 104 ± 13 for major lesions, minor lesions, and normal MRI, respectively). Median total impairment score (TIS) was significantly higher in children with major lesions on ultrasound or MRI as well as in children with minor lesions on MRI (TIS 4.0 and 6.25 for normal and minor lesions on MRI, respectively; p < 0.0001). Conclusions: A normal neonatal cranial ultrasound excluded a severe lesion on MRI in 99% of cases. MRI correlated more strongly with mean IQ and median TIS than ultrasound. Subtle white matter lesions are better detected with MRI which could explain the stronger correlation of MRI with IQ and motor performance.展开更多
BACKGROUND: We conducted a nationwide study in the Netherlands to determine cl inical features and prognostic factors in adults with community acquired acute bacterial meningitis. METHODS: From October 1998 to April 2...BACKGROUND: We conducted a nationwide study in the Netherlands to determine cl inical features and prognostic factors in adults with community acquired acute bacterial meningitis. METHODS: From October 1998 to April 2002, all Dutch patien ts with community acquired acute bacterial meningitis, confirmed by cerebrospin al fluid cultures, were prospectively evaluated. All patients underwent a neurol ogic examination on admission and at discharge, and outcomes were classified as unfavorable (defined by a Glasgow Outcome Scale score of 1 to 4 points at discha rge) or favorable (a score of 5). Predictors of an unfavorable outcome were iden tified through logis tic regression analysis. RESULTS: We evaluated 696 episod es of community acquired acute bacterial meningitis. The most common pathogens were Streptococcus pneumoniae (51 percent of pisodes) and Neisseria meningitidis (37 percent). The classic triad of fever, neck stiffness, and a change in menta l status was present in only 44 percent of episodes; however, 95 percent had at least two of the four symptoms of headache, fever, neck stiffness, and altered m ental status. On admission, 14 percent of patients were comatose and 33 percent had focal neurologic abnormalities. The overall mortality rate was 21 percent. T he mortality rate was higher among patients with pneumococcal meningitis than am ong those with meningococcal meningitis (30 percent vs. 7 percent, P< 0.001). Th e outcome was unfavorable in 34 percent of episodes. Risk factors for an unfavor able outcome were advanced age, presence of otitis or sinusitis, absence of rash, a low score on the Glasgow Coma Scale on admission , tachycardia, a positive blood culture, an elevated erythrocyte sedimentation r ate, thrombocytopenia, and a low cerebrospinal fluid white cell count. In adult s presenting with community acquired acute bacterial meningitis, the sensitivit y of the classic triad of fever, neck stiffness, and altered mental status is lo w, but almost all present with at least two of the four symptoms of展开更多
Alcohol septal ablation(ASA) reduces left ventricular outflow tract(LVOT) pressure gradient in patients with hypertrophic obstructive cardiomyopathy(HOCM),which leads to left ventricular remodeling. We sought to descr...Alcohol septal ablation(ASA) reduces left ventricular outflow tract(LVOT) pressure gradient in patients with hypertrophic obstructive cardiomyopathy(HOCM),which leads to left ventricular remodeling. We sought to describe the early to midterm changes and modulating factors of the remodeling process using cardiac MRI(CMR). Methods and Results-CMR was performed at baseline and 1 and 6 months after ASA in 29 patients with HOCM(age 52± 16 years). Contrast enhanced CMR showed no infarct-related hyperenhancement outside the target septal area. Septal mass decreased from 75± 23 g at baseline to 68± 22 and 58± 19 g(P< 0.001) at 1-and 6-month follow-up, respectively. Remote, nonseptal mass decreased from 141± 41 to 132± 40 and 111± 27 g(P< 0.001), respectively. Analysis of temporal trends revealed that septal mass reduction was positively associated with contrast-enhanced infarct size and transmural or left-sided septal infarct location at both 1 and 6 months. Remote mass reduction was associated with infarct location at 6 months but not with contrast-enhanced infarct size. By linear regression analysis, percentage remote mass reduction correlated significantly with LVOT gradient reduction at 6-month follow-up(P=0.03). Conclusions-Left ventricular remodeling after ASA occurs early and progresses on midterm follow-up, modulated by CMR infarct size and location. Remote mass reduction is associated with infarct location and correlates with reduction of the LVOT pressure gradient. Thus, myocardial hypertrophy in HOCM is, at least in part, afterload dependent and reversible and is not exclusively caused by the genetic disorder.展开更多
AIM: To identify the typical shape of the rise and fall curve of troponin(Tn) following the different types of myocardial infarction(MI). METHODS: We conducted a systematic search in PubM ed and Embase including all s...AIM: To identify the typical shape of the rise and fall curve of troponin(Tn) following the different types of myocardial infarction(MI). METHODS: We conducted a systematic search in PubM ed and Embase including all studies which focused on the kinetics of Tn in MI type 1, type 4 and type 5. Tn levels were standardized using the 99 th percentile, a pooled mean with 95%CI was calculated from the weighted means for each time point until 72 h. RESULTS: A total of 34 of the 2528 studies identified in the systematic search were included. The maximum peak level of the Tn was seen after 6 h after successful reperfusion of an acute MI, after 12 h for type 1 MI and after 72 h for type 5 MI. In type 1 MI there were additional smaller peaks at 1 h and at 24 h. After successful reperfusion of an acute MI there was a second peak at 24 h. There was not enough data available to analyze the Tn release after MI associated with percutaneous coronary intervention(type 4).CONCLUSION: The typical rise and fall of Tn is different for type 1 MI, successful reperfusion of an acute MI and type 5 MI, with different timing of the peak levels and different slopes of the fall phase.展开更多
文摘 Lung cancer is the most common cause of death from cancer in males,accounting for more than 1.4 million deaths in 2008.It is a growing concern in China,Asia and Africa as well.Accurate staging of the disease is an important part of the management as it provides estimation of patient’s prognosis and identifies treatment sterategies.It also helps to build a database for future staging projects.A major revision of lung cancer staging has been announced with effect from January 2010.The new classification is based on a larger surgical and non-surgical cohort of patients,and thus more accurate in terms of outcome prediction compared to the previous classification.There are several original papers regarding this new classification which give comprehensive description of the methodology,the changes in the staging and the statistical analysis.This overview is a simplified description of the changes in the new classification and their potential impact on patients’ treatment and prognosis.
基金research support of the Department of Radiology,UW-Madison and GE Healthcare
文摘Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA) is useful for the primary diagnosis of pulmonary embolism(PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography(CTA). In this review, we discuss the strengths and weaknesses of CEMRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multiinstitutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women(< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness(patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.
文摘In recent years,the use of light to selectively and precisely activate drugs has been developed along the fundamental concepts of photopharmacology.One of the key methods in this field relies on transiently silencing the drug activity with photocleavable protecting groups(PPGs).To effectively utilize light-activated drugs in future medical applications,physicians will require a reliable method to assess whether light penetrates deep enough into the tissues to activate the photoresponsive theragnostic agents.Here,we describe the development and evaluation of magnetic resonance(MR)imaging agents that allow for the detection of light penetration and drug activation in the tissues using non-invasive whole-body magnetic resonance imaging(MRI)and chemical exchange saturation transfer(CEST)-MRI modalities.The approach relies on the use of PPG-protected MR contrast agents,which upon irradiation with light change their imaging signal.A Gadolinium(III)-based MRI contrast agent is presented that undergoes a significant change in relaxivity(25%)upon uncaging,providing a reliable indicator of lightinduced cargo release.Additionally,we introduce the first light-responsive CESTMRI imaging agent,enabling positive signal enhancement(off-to-on)upon light activation,offering a novel approach to visualize the activation of photoactive agents in living tissues.This research provides a proof-of-principle for the noninvasive,whole-body imaging of light penetration and drug activation with high temporal resolution characteristic of MR methods.
文摘This article explains the phasing in the design of associate degree programs in the Netherlands.The associate degree is a degree on Level5 and is described in this article.The associate degree programs organize themselves in new developed Regional Associate Colleges.Design teams consists of teachers from different institutes.The design team leader’s tasks and focus within the different phases in designs is addressed.
基金part of the CASCAPE project funded by the Dutch Ministry of Foreign Affairs through the Embassy of the Kingdom of the Netherlands in Addis Ababa,Ethiopia(5120915001).
文摘Urban population growth is driving the expansion of urban and peri-urban agriculture(UPA)in developing countries.UPA is providing nutritious food to residents but the manures produced by UPA livestock farms and other wastes are not properly recycled.This paper explores the effects of four scenarios:(1)a reference scenario(business as usual),(2)increased urbanization,(3)UPA intensification,and(4)improved technology,on food-protein self-sufficiency,manure nitrogen(N)recycling and balances for four different zones in a small city(Jimma)in Ethiopia during the period 2015-2050.An N mass flow model with data from farm surveys,field experiments and literature was used.A field experiment was conducted and N use efficiency and N fertilizer replacement values differed among the five types of composts derived from urban livestock manures and kitchen wastes.The N use efficiency and N fertilizer replacement values were used in the N mass flow model.Livestock manures were the main organic wastes in urban areas,although only 20 to 40%of animal-sourced food consumed was produced in UPA,and only 14 to 19%of protein intake by residents was animal-based.Scenarios indicate that manure production in UPA will increase 3 to 10 times between 2015 and 2050,depending on urbanization and UPA intensification.Only 13 to 38%of manure N will be recycled in croplands.Farm-gate N balances of UPA livestock farms will increase to>1 t·ha−1 in 2050.Doubling livestock productivity and feed protein conversion to animal-sourced food will roughly halve manure N production.Costs of waste recycling were high and indicate the need for government incentives.Results of these senarios are wake-up calls for all stakeholders and indicate alternative pathways.
文摘Aim: To examine the correlation between neonatal cranial ultrasound and school age magnetic resonance imaging (MRI) and neurodevelopmental outcome. Methods: In a prospective 2 year cohort study, 221 children (gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g) participated at a median age of 8.1 years (inclusion percentage 78% ). Conventional MRI, IQ (subtests of the WISC), and motor performance (Movement Assessment Battery for Children) at school age were primary outcome measurements. Results: Overall, there was poor correspondence between ultrasound group classifications and MRI group classifications, except for the severe group (over 70% agreement). There was only a 1% chance of the children with a normal cranial ultrasound having a major lesion on MRI. Mean IQ (standard deviation) was significantly lower in children with major ultrasound or MRI lesions, but was also lower in children with minor lesions on MRI compared to children with a normal MRI (91 ± 16, 100 ± 13, 104 ± 13 for major lesions, minor lesions, and normal MRI, respectively). Median total impairment score (TIS) was significantly higher in children with major lesions on ultrasound or MRI as well as in children with minor lesions on MRI (TIS 4.0 and 6.25 for normal and minor lesions on MRI, respectively; p < 0.0001). Conclusions: A normal neonatal cranial ultrasound excluded a severe lesion on MRI in 99% of cases. MRI correlated more strongly with mean IQ and median TIS than ultrasound. Subtle white matter lesions are better detected with MRI which could explain the stronger correlation of MRI with IQ and motor performance.
文摘BACKGROUND: We conducted a nationwide study in the Netherlands to determine cl inical features and prognostic factors in adults with community acquired acute bacterial meningitis. METHODS: From October 1998 to April 2002, all Dutch patien ts with community acquired acute bacterial meningitis, confirmed by cerebrospin al fluid cultures, were prospectively evaluated. All patients underwent a neurol ogic examination on admission and at discharge, and outcomes were classified as unfavorable (defined by a Glasgow Outcome Scale score of 1 to 4 points at discha rge) or favorable (a score of 5). Predictors of an unfavorable outcome were iden tified through logis tic regression analysis. RESULTS: We evaluated 696 episod es of community acquired acute bacterial meningitis. The most common pathogens were Streptococcus pneumoniae (51 percent of pisodes) and Neisseria meningitidis (37 percent). The classic triad of fever, neck stiffness, and a change in menta l status was present in only 44 percent of episodes; however, 95 percent had at least two of the four symptoms of headache, fever, neck stiffness, and altered m ental status. On admission, 14 percent of patients were comatose and 33 percent had focal neurologic abnormalities. The overall mortality rate was 21 percent. T he mortality rate was higher among patients with pneumococcal meningitis than am ong those with meningococcal meningitis (30 percent vs. 7 percent, P< 0.001). Th e outcome was unfavorable in 34 percent of episodes. Risk factors for an unfavor able outcome were advanced age, presence of otitis or sinusitis, absence of rash, a low score on the Glasgow Coma Scale on admission , tachycardia, a positive blood culture, an elevated erythrocyte sedimentation r ate, thrombocytopenia, and a low cerebrospinal fluid white cell count. In adult s presenting with community acquired acute bacterial meningitis, the sensitivit y of the classic triad of fever, neck stiffness, and altered mental status is lo w, but almost all present with at least two of the four symptoms of
文摘Alcohol septal ablation(ASA) reduces left ventricular outflow tract(LVOT) pressure gradient in patients with hypertrophic obstructive cardiomyopathy(HOCM),which leads to left ventricular remodeling. We sought to describe the early to midterm changes and modulating factors of the remodeling process using cardiac MRI(CMR). Methods and Results-CMR was performed at baseline and 1 and 6 months after ASA in 29 patients with HOCM(age 52± 16 years). Contrast enhanced CMR showed no infarct-related hyperenhancement outside the target septal area. Septal mass decreased from 75± 23 g at baseline to 68± 22 and 58± 19 g(P< 0.001) at 1-and 6-month follow-up, respectively. Remote, nonseptal mass decreased from 141± 41 to 132± 40 and 111± 27 g(P< 0.001), respectively. Analysis of temporal trends revealed that septal mass reduction was positively associated with contrast-enhanced infarct size and transmural or left-sided septal infarct location at both 1 and 6 months. Remote mass reduction was associated with infarct location at 6 months but not with contrast-enhanced infarct size. By linear regression analysis, percentage remote mass reduction correlated significantly with LVOT gradient reduction at 6-month follow-up(P=0.03). Conclusions-Left ventricular remodeling after ASA occurs early and progresses on midterm follow-up, modulated by CMR infarct size and location. Remote mass reduction is associated with infarct location and correlates with reduction of the LVOT pressure gradient. Thus, myocardial hypertrophy in HOCM is, at least in part, afterload dependent and reversible and is not exclusively caused by the genetic disorder.
文摘AIM: To identify the typical shape of the rise and fall curve of troponin(Tn) following the different types of myocardial infarction(MI). METHODS: We conducted a systematic search in PubM ed and Embase including all studies which focused on the kinetics of Tn in MI type 1, type 4 and type 5. Tn levels were standardized using the 99 th percentile, a pooled mean with 95%CI was calculated from the weighted means for each time point until 72 h. RESULTS: A total of 34 of the 2528 studies identified in the systematic search were included. The maximum peak level of the Tn was seen after 6 h after successful reperfusion of an acute MI, after 12 h for type 1 MI and after 72 h for type 5 MI. In type 1 MI there were additional smaller peaks at 1 h and at 24 h. After successful reperfusion of an acute MI there was a second peak at 24 h. There was not enough data available to analyze the Tn release after MI associated with percutaneous coronary intervention(type 4).CONCLUSION: The typical rise and fall of Tn is different for type 1 MI, successful reperfusion of an acute MI and type 5 MI, with different timing of the peak levels and different slopes of the fall phase.
